Disability Risk in Work-Related Musculoskeletal Injury

描述： 绝大多数成本和生产力损失都发生在工人的工作中。 补偿是由于与工作有关的肌肉骨骼损伤。受伤者中 具有这些条件的工人中，一小部分（5-10%）会发展 长期残疾并占成本和损失的大部分（80-85%） 工作。由于缺乏准确的方法来识别面临风险的工人 长期致残，二级预防工作不能有针对性。 这是一项针对华盛顿州的为期 5 年、基于人群的前瞻性研究 患有背部受伤和腕管综合症 (CTS) 的工人。主要目标 是开发一个准确的长期残疾风险预测模型 5个关键风险维度：就业相关因素；生物医学保健 相关因素；社会人口因素；行政/法律因素；和 心理社会因素。为了实现这一目标，需要进行基线访谈 大约 3000 名符合资格的工人将在 2-6 周内接受培训 （工人赔偿）索赔津贴。残疾的连续测量 结果（损失时间补偿）将由计算机确定 数据库一年。其他重要成果将由 一年后的后续面试（功能状态、工作状态） 计算机化记录（工作状况、工资状况）。多变量生存分析 在风险维度内和跨风险维度将用于开发主要风险 模型，包括根据伤害严重程度进行调整。可靠性 还将确定医疗记录的严重程度（具体 目标2）。本研究的第三个目的是进行简短的风险评估 用于腰背和 CTS 损伤的仪器，这对于 医生在首次治疗受伤工人时。主要关注这些 工具将针对那些可能改变的风险因素 可能适合早期干预以预防残疾。统计 为此目的的分析将侧重于特定的敏感性和特异性 风险因素的组合。这些风险评估工具将试点 在参与职业保健质量的医生中进行测试 改进项目。该项目的第四个目标是确定再次伤害 原始腰背损伤队列 2 中再损伤的发生率和预测因素 初次受伤后数年。华盛顿独特的学习环境 状态，包括及时进行基于人群的抽样的能力 调查受伤工人、医疗、索赔和工作状况的联系 数据库以及企业界和劳工界的支持，将 对本研究的成功做出了重大贡献。

DESCRIPTION: The vast majority of cost and lost productivity in workers' compensation is due to work related --musculoskeletal injuries. Among injured workers with these conditions, a small proportion (5-10 percent) develops long-term disability and account for most (80-85 percent) of the cost and lost work. In the absence of an accurate method to identify workers at risk for long-term disability, secondary prevention efforts cannot be well targeted. This is a 5-year, population-based, prospective study among Washington State workers with back injuries and carpal tunnel syndrome (CTS). The principal aim is to develop an accurate predictive model of risk for long-term disability among 5 key risk dimensions: employment related factors; biomedical healthcare related factors; socio-demographic factors; administrative/legal factors; and psychosocial factors. To accomplish this aim, a baseline interview among approximately 3000 eligible workers will be conducted within 2-6 weeks of (workers compensation) claim allowance. A continuous measure of disability outcome (lost time compensation) will be determined from a computerized database at one year. Additional important outcomes will be determined by a follow-up interview at one year (functional status, work status) and from computerized records (work status, wage status). Multivariate survival analysis within and across risk dimensions will be used to develop the principal risk models, including adjustment for injury severity. The reliability of determining severity from medical records will be determined as well (Specific Aim 2). A third aim of this study is to develop a brief risk assessment instrument for both low back and CTS injuries which would be useful to physicians when first treating injured workers. The main focus of these instruments would be on those risk factors which may be modifiable and which may be amenable to early intervention to prevent disability. Statistical analysis for this aim will focus on sensitivity and specificity of specific combinations of risk factors. These risk assessment instruments will be pilot tested among physicians participating in an occupational health care quality improvement project. The fourth aim of this project is to determine reinjury rate and predictors of reinjury among the original low back injury cohort 2 years after the initial injury. The unique study environment in Washington state, including the ability to conduct population-based sampling, timely access to survey injured workers, linkage of medical, claims and work status databases, and support from the business and labor communities, will substantially contribute to the success of this study.